What is a potential sign of adrenal insufficiency after discontinuing long-term corticosteroid use?

A potential sign of adrenal insufficiency after discontinuing long-term corticosteroid use is hypoglycemia. When corticosteroids are taken over a prolonged period, they help regulate metabolism by increasing gluconeogenesis and glycogenolysis, leading to higher blood glucose levels. The body adapts to this external source of cortisol and can decrease its own production of cortisol from the adrenal glands.

When corticosteroid therapy is suddenly discontinued, the adrenal glands may not respond quickly enough to meet the body’s metabolic needs, particularly in maintaining normal blood glucose levels. This deficiency can result in hypoglycemia, as the body's ability to generate glucose is impaired without adequate cortisol production. Symptoms of adrenal insufficiency can include fatigue, weakness, and dizziness, which are often related to insufficient glucose availability in the bloodstream.

Understanding this mechanism highlights the importance of tapering corticosteroid medications rather than stopping them abruptly, to allow the adrenal glands to recover and start producing sufficient cortisol again.